1. Syria,2004 Medicine price survey in Syria, 2004 undertaken by Pharmaceutical Studies Directorate, Ministry of Health Presentation by Razan Sallouta WHO/HAI post-medicine price survey regional workshop, Cairo 7-9 January 2007

2. Syria,2004 Country background Population in millions: 18 Population in millions: 18 % of rural population:49.8 % % of rural population:49.8 % Total adult literacy rate: 93 % Total adult literacy rate: 93 % GDP per capita: 1216 US $ GDP per capita: 1216 US $ Total health expenditure/capita: 55.46US $; 4.56 % of GDP Total health expenditure/capita: 55.46US $; 4.56 % of GDP Government health expenditure/capita : 27.25US $; 2.25%of GDP Government health expenditure/capita : 27.25US $; 2.25%of GDP National Health Insurance exists in Public Sector National Health Insurance exists in Public Sector

3. Syria,2004 Methodology Number of medicines surveyed: 27 Core 22 Supplementary 5 Note: only 13 innovator brands surveyed Year of MSH reference price used: 2002 Number of regions surveyed: 4 Total number of facilities sampled: 100 Sector (patient prices)Number PublicNS Private retail pharmacies57 Other sector: Private patients in private sections of public hospitals 43 NS = not surveyed

4. Syria,2004 Availability PrivateOther: Private inpatients in public hospitals IBLPGIBLPG Median availability0% (n=27) 95% (n=13) 98%0% 93%

5. Syria,2004 Prices: summary MPRs and examples ProcurementPrivateOther: Private inpatients IBLPGIBLPGIBLPG Median MPR6.991.549.62.511.9 diclofenac 21.68 4.5223.716.324.74 loratadine 2.920.723.410.980.77 amitriptyline 3.052.773.882.91 IB = innovator brand LPG = lowest priced generic

6. Syria,2004 Affordability (No. of days wages) Daily wage 100 SPPrivateOther: private inpatients ~ $ 2 US IBLPGIBLPG Co-trimoxazole, 8+40mg/ml, suspension, 70ml 0.50.2 Atenolol, 50mg, tab, 301.80.60.5 Diclofenac, 25mg, tab, 603.20.80.6

7. Syria,2004 Price components – Syrian pricing formula Type of chargeAmount of charge Raw materials, manufacturing & packagingCost price Manufacturer's profit20% Propaganda8% Wholesalers mark-up8% Pharmacists mark-up is regressive, based on pharmacists procurement price 1 – 40 SP30% 41 – 80 SP20% 81 – 200 SP15% 201 – 500 SP10% 501 and over8% Note: pharmacy markup is not applied across total procurement price eg if procurement price is 75 SP then mark-up is 30% for first 40 SP plus 20% for remaining 35 SP

8. Syria,2004 Main Findings 1- Availability of generics was very good – in public hospitals & private pharmacies 2- In the private sector, innovator brands were high priced. Most generics were reasonably priced although some were expensive. 3- Some treatments, even with generics, are not affordable to low-paid Syrians 4- Some public procurement prices are high compared to MSH reference prices

9. Syria,2004 Recommendations The findings of this study should be used to adjust the draft national medicines policy An in-depth study of the private sector should be initiated to investigate prescribing and dispensing practices, including whether innovator brands are more frequently prescribed than generic equivalents Where prices of specific medicines are very high (MPR of 10 or more), investigation should occur to identify means to reduce these prices Study pricing methods in other countries Monitor the impact of policy changes by regular surveys of medicine prices, availability and affordability

10. Syria,2004 Follow-up activities 1- Plan to increase the number of medicines that should be surveyed. 2- Use the survey findings to develop and implement policies and practices that result in lower prices, and more affordable treatments for all Syrians.